Healthcare Provider Details

I. General information

NPI: 1174872733
Provider Name (Legal Business Name): MEGAN MARIE KEGLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 LINCOLN DR
SPRINGFIELD KY
40069-1577
US

IV. Provider business mailing address

PO BOX 990
DANVILLE KY
40423-0990
US

V. Phone/Fax

Practice location:
  • Phone: 859-336-9801
  • Fax:
Mailing address:
  • Phone: 859-239-2360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007585
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: